Health Cover for Major Illness in France
Thursday 02 July 2015
Most costs of a chronic illness in France are covered by the State, but patients remain liable for some charges, with more likely to be on the way in the future.
Unlike the health system in the UK, the French health system is not free at the point of service.
If you need medical care in France you incur a charge, some of which is reimbursable by the State and the rest is the responsibility of the patient.
In order to cover the charges not reimbursed by the State the vast majority of residents take out complementary ('top-up') health cover, called assurance complementaire.
However, in one very important respect the State does accept full responsibility, and that is in relation to chronic illnesses, called Affection de Longue Durée (ALD).
An ALD is defined in French law as a 'condition requiring long-term care and particularly costly treatment’. The illness is one that must require medical treatment for at least six months.
There exists a prescribed list of such illnesses and only those on the list are accepted for full cover. Even where the illness is on the list, certain charges remain the responsibility of the patient.
If you need medical care in France you incur a charge, some of which is reimbursable by the State and the rest is the responsibility of the patient.
In order to cover the charges not reimbursed by the State the vast majority of residents take out complementary ('top-up') health cover, called assurance complementaire.
However, in one very important respect the State does accept full responsibility, and that is in relation to chronic illnesses, called Affection de Longue Durée (ALD).
An ALD is defined in French law as a 'condition requiring long-term care and particularly costly treatment’. The illness is one that must require medical treatment for at least six months.
There exists a prescribed list of such illnesses and only those on the list are accepted for full cover. Even where the illness is on the list, certain charges remain the responsibility of the patient.
Prescribed List
The prescribed list of illnesses for which the State accepts full responsibility contains 29 pathologies on it. They include cancer, diabetes (type 1 and 2), serious heart disorder, dementia, Parkinson's, grave neurological or muscular diseases, and chronic lung disease.
In addition, there exists illnesses not on the list but requiring extended care or particularly costly treatment. Although not defined, the illness (or condition) must require medical treatment for not less than six months.
If your doctor considers that you have an affection de longue durée they will make application to the local health authority who will assess your case and make the ultimate decision as to whether or not you will be entitled to 100% medical cover for the illness.
Whether or not such an application will be made will depend on the attitude of your doctor. Although doctors have been issued with guidance, some are inclined to make application whatever stage the illness has reached, whilst others take the view that until or unless it reaches an advanced stage an application is not deemed appropriate.
Once your name has been added to the ALD list you need to make sure that your health card (carte vitale) is updated by the chemist, or you will otherwise receive only partial reimbursement for prescriptions.
Government advisors have recently argued that there should be a tightening of rules relating to access to ALD, either by reducing the number of conditions covered, or by imposing a minimum level of charges on patients. This report is being considered by the government.
In addition, there exists illnesses not on the list but requiring extended care or particularly costly treatment. Although not defined, the illness (or condition) must require medical treatment for not less than six months.
If your doctor considers that you have an affection de longue durée they will make application to the local health authority who will assess your case and make the ultimate decision as to whether or not you will be entitled to 100% medical cover for the illness.
Whether or not such an application will be made will depend on the attitude of your doctor. Although doctors have been issued with guidance, some are inclined to make application whatever stage the illness has reached, whilst others take the view that until or unless it reaches an advanced stage an application is not deemed appropriate.
Once your name has been added to the ALD list you need to make sure that your health card (carte vitale) is updated by the chemist, or you will otherwise receive only partial reimbursement for prescriptions.
Government advisors have recently argued that there should be a tightening of rules relating to access to ALD, either by reducing the number of conditions covered, or by imposing a minimum level of charges on patients. This report is being considered by the government.
Patient Charges
Even under current rules, although the State formally picks up the charges for treatment of an ALD, there remain a number of charges the responsibility of the patient.
i. Other Illnesses - You will only be entitled to partial reimbursement for all other illnesses. In some cases, ancillary medication that is not directly related to the chronic illness may also only reimbursed on a partial basis.
ii. Consultant Surcharges - An increasing number of hospital consultants and other medical specialists impose charges over and above the standard fixed tariff set by the government on which reimbursements are based. These additional 'depassement honoraires' are not covered by ALD.
iii. Daily Hospital Charge - If you are admitted to hospital for over 24 hours you will be required to pay a daily accommodation rate of €18, called the 'forfait journalier hospitalier' which is the responsibility of the patient. In addition you may be obliged to pay certain other hospital charges, such as an additional charge for a single room, television and telephone.
iv. Medical Consultations - All patients are required to pay €1 for each medical consultation or analyses, irrespective of whether or not they have full insurance cover. This is called the 'participation forfaitaire'.
v. Franchise Medical - You will be required to pay 50 cents towards the cost of all medicines, except those given during hospitalisation. There is a similar charge for auxiliary medical treatments, such as physiotherapy. You are also required to pay €2 towards the cost of medical transport if needed, save for emergencies. All to the limit of €50 per year.
All of these costs, save for the €1 'participation forfaitaire', may be reimbursed by your complementary policy, although it will depend on the terms of the policy.
i. Other Illnesses - You will only be entitled to partial reimbursement for all other illnesses. In some cases, ancillary medication that is not directly related to the chronic illness may also only reimbursed on a partial basis.
ii. Consultant Surcharges - An increasing number of hospital consultants and other medical specialists impose charges over and above the standard fixed tariff set by the government on which reimbursements are based. These additional 'depassement honoraires' are not covered by ALD.
iii. Daily Hospital Charge - If you are admitted to hospital for over 24 hours you will be required to pay a daily accommodation rate of €18, called the 'forfait journalier hospitalier' which is the responsibility of the patient. In addition you may be obliged to pay certain other hospital charges, such as an additional charge for a single room, television and telephone.
iv. Medical Consultations - All patients are required to pay €1 for each medical consultation or analyses, irrespective of whether or not they have full insurance cover. This is called the 'participation forfaitaire'.
v. Franchise Medical - You will be required to pay 50 cents towards the cost of all medicines, except those given during hospitalisation. There is a similar charge for auxiliary medical treatments, such as physiotherapy. You are also required to pay €2 towards the cost of medical transport if needed, save for emergencies. All to the limit of €50 per year.
All of these costs, save for the €1 'participation forfaitaire', may be reimbursed by your complementary policy, although it will depend on the terms of the policy.
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